04 Airway Management Flashcards
What is the Oropharyngeal Airways (OPA) device?
A curved piece of plastic inserted over the tongue that creates an air passageway between the mouth and the posterior pharyngeal wall.
What is OPA useful for?
Useful for anesthetized/unconscious patients whose tongue/epiglottis fall back against the posterior pharynx and obstrcuts air flow
When is OPA Indicated?
For pt who do not have a cough/gag/swallow reflex
When is OPA contrainidcated?
In a person who is conscious, intact cough, gag or swallow reflex
How do you measure for OPA devices?
To measure the approximate size of the OPA: hold the airway next to the patient’s upper jaw with the front even with the patient’s teeth/ corner of the patient’s mouth to the angle of the jaw.
OPA assessment intially?
Initially after – pass hand over the OPA to feel for breath
What are ongoing assessments for OPA? (4)
- Suction orally prn
- ongoing assessment of airway in mouth and breath sounds every 2-4 hours and PRN
- Perform mouth care every two hours
- Remove OPA, assess oral mucosa and tongue, and replace at least once every four to eight hours if kept in place – rarely done
What are NPAs used for?
Inserted into nostril to create an air passage between the nose and the nasopharynx.
What do you do before inserting NPAs?
Preinsertion – lubricate tube with water based lubricant, advance at an angle perpendicular to the face
What are NPAs indicated for?
Indicated for patients with intact cough (weak) and gag reflex who require frequent suctioning but unable to forcefully cough or adequately clear secretions
NPAs are contraindicarted in what Pts? 6
Contraindicated in patients:
- Who are anticoagulated
- Have low platelet count
- Bibasilar skull fx
- Basel formities
- Facial trauma
- May be contraindicated in children d/t increased risk of epistaxis
What are complications associated with NPAs?
Complications:
- Trauma to nares
- Airway obstruction
- Larygospasm
- Gagging and vomiting
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How do you measure for NPAs?
NPA length – distance from the nares to the tragus of the ear.
Measure from the tip of the nose to earlobe
Circumference smaller than diameter of nostril
Insert until flange is against nostril opening
What are ongoing assessments after an NPA?
- Ö placement by feeling for air from nostril where NPA is placed. As you do with oral airway.
- Check posterior airway:
- Auscultate lung sounds
- Remove the airway at lease every 8 hours and replace with a new NPA after examining nasal mucosa and nares. Ensure NPA does not fit too tightly restricting circulation to mucosa of nostril.
What are some disadvantages of NPAs?
Nares must be closely monitored for skin breakdown if used for a few days.
Which is one, OPA vs NPA, is better for consciouc pt with a gag reflex?
NPAs
What’s the most effective method to clear the airways?
Coughing and deep breathing.
It will decrease the risk of atelectasis and penumonia if done with early mobility / ambulation.
If there’s an incision, tell pt to hold pillow firmly over incision when coughing
What is an incentive spirometer used for?
- Promotes deep breathing and good inspiratory effort
- Frequently used in post op patients to minimize risk of atelectasis and development of PNA
- Can be used with patients on bedrest
- Done hourly while awake
What are Peak Flow Measurements used for?
- provide baseline best maximal expiration to evaluate airway diameter.
- Used to determine meds to minimize future asthma attacks
- Will determine the best efforts after bronchodilator therapy
- Provides info as to when to use rescue inhalers
- Helps to determine if there will be failure to respond to treatments
- Helps the patient understand when they should seek emergency interventions for bronchospasm
Rate of Neb infusion?
Runs on what?
- Delivers med over 5-10 minutes
- Run on air – preferably
- Flow should be 6-8 liters. If to high patient may receive less med and too low patient may get tired of treatment and stop before completed
Why are metered dose inhalers useful?
- Spacer is useful esp with patients who cannot grasp the steps for using an MDI
- It is the preferred method for inhaled medications
What is postural drainage?
Use of gravity to facilitate movement and expectoration of secretions & mucous from various lobes of the lungs and the airways.
What is Cupping?
Cupping is a gentle rhthmic clapping/cupping parts of the lungs to move/loosen mucus from bronchioles
PD&C – postural drainage and cupping
The combination of postural drainage and cupping are often used together to treat what? (3)
- CF pt
- Spinal cord injury
- Pt with pneumonia
What does the vibration technique entail and do?
- Technique used in conjunction with percussion and postural drainage…but can be used alone
- Hands on chest using rapid vibration as patient exhales
- Helps to loosed secretions, promotes cough to clear airways
- Devices available to provide vibration are more common then this procedure
Contraindications to Postural Drainage and Cupping?
- Contraindications
- Head injuries, ICP
- COPD
- History of cardiac disorders – but may be used in some cases especially in pediatrics.
What are indications for bag valve mask devices/resuscitation breathing bags?
- Hypoxia, decreased O2 sats that don’t recover with increasing oxygenation
- Hypoventilation (RR,8) and don’t increase with stimulation
- Resp failure or worsening resp status that does not support adequate oxygenation or ventilation
- Resp arrest
Bag valve mask ventilation technique?
- May deliver breaths without oxygen, then use oxygen when available
- Deliver all breaths over 1 second
- Deliver breaths in a person with spontaneous circulation: one every 6 – 8 seconds or 8 – 10 breaths per minute – sync with their effort to breath or in between patient’s own breaths
- Generally deliver breaths to a person in full respiratory arrest: one every 6 seconds or 10 breaths per minute
- If CPR, 30:2 compression-ventilation ratio
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